Physicians’ perspectives on prescribing benzodiazepines for older adults: a qualitative study
Open accessAbstract
Background There is a continued high prevalence of benzodiazepine use by older community-residing adults and of their continued prescription by practitioners, despite well known adverse effects and the availability of safer, effective alternatives.Objectives To understand factors influencing chronic use of benzodiazepines in older adults.Design Qualitative study, semistructured interviews with physicians.Participants Thirty-three practicing primary care physicians around Philadelphia.Approach Qualitative interviews were audiotaped, transcribed, and entered into a qualitative software program. A multidisciplinary team coded transcripts and developed themes.Results Physicians generally endorsed benzodiazepines as effective treatment for anxiety, citing quick action and strong patient satisfaction. The use of benzodiazepines in older adults was not seen to be problematic because they did not show drug-seeking or escalating dose behavior suggesting addiction. Physicians minimized other risks of benzodiazepines and did not view monitoring or restricting renewal of prescriptions as an important clinical focus relative to higher-priority medical issues. Many physicians expressed skepticism about risks of continued use and considerable pessimism in the successful taper/discontinuation in older patients with long-term use and prior failed attempts. Physicians also anticipated patient resistance to any such efforts, including switching physicians.Conclusions Primary care physicians are averse to addressing the public health problem of benzodiazepine overuse in the elderly. Their attitudes generally conflict with practice guidelines and they complain of a lack of training in constructive strategies to address this problem. A 2-pronged effort should focus on increasing skill level and preventing new cases of benzodiazepine dependency through improved patient education and vigilant monitoring of prescription renewal.
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The most frequent indications for psychotropic prescribing were depression in nine studies, sleeping disorders in seven and anxiety in six.
“The most frequent indications for psychotropic prescribing were depression in nine studies [50, 51, 55, 56, 60, 62, 73, 74, 82], sleeping disorders in seven [54–56, 59, 63, 74, 82] and anxiety in six [54–56, 73, 74, 82].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
The Results section identifies anxiety and sleep problems as reasons physicians gave for benzodiazepine use. It does not establish depression as a prescribing indication; the Results instead say physicians did not consider benzodiazepines a stand-alone treatment for major depressive disorder. This qualitative study also does not supply the sentence’s counts of studies for each indication. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOlder patients expressed the view that they did not wish to 'experiment' at their age by tapering or discontinuing their psychotropic medication.
“older patients expressed the view that they did not wish to ‘experiment’ at their age by tapering or discontinuing their psychotropic medication [54–56, 59].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
The Results section (“Anticipated Resistance from Patients”; page unavailable) reports physicians’ accounts of older patients resisting benzodiazepine tapering, including a patient who said she had taken lorazepam for thirty years. It does not report patients saying they did not want to ‘experiment’ at their age, and its evidence concerns benzodiazepines rather than psychotropic medication generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredDoctors anticipated resistance to discontinuation of psychotropic medication or introduction of non-pharmacological interventions.
“Doctors anticipated resistance to discontinuation of psychotropic medication or introduction of non-pharmacological interventions”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
The Results section reports that physicians anticipated patient resistance to tapering or discontinuing benzodiazepines and thought older patients would resist or be unable to pursue mental health referrals. These passages support both types of anticipated resistance, but the study concerns benzodiazepines specifically, not psychotropic medication generally. (LLM, conf=0.85)
Experimental — accuracy not yet measuredSide effects associated with psychotropic medication were also minimised by some older people, doctors and family members.
“However, side effects associated with psychotropic medication were also minimised by some older people, doctors and family members [54–56, 59, 63, 65, 74, 81, 82].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
In Results, under “Little Recognition of Adverse Effects Other than Addiction,” the paper says physicians largely minimized or ignored adverse effects of benzodiazepines. Another Results passage says physicians anticipated that older patients might minimize negative side effects; it does not establish this from patients’ own accounts. The paper does not support the claim about family members, and its findings concern benzodiazepines rather than psychotropic medication generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredDoctors and nurses were of the view that assessing whether psychotropic medication was appropriate in older people was challenging.
“Doctors and nurses were of the view that assessing whether psychotropic medication was appropriate in older people was challenging [49, 53–56, 62, 65, 80–82].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
The Discussion (page unavailable) describes physicians’ formidable challenges in addressing chronic benzodiazepine use in older patients, which supports the claim’s general point about difficulty. The study interviewed physicians, not nurses, and focused on benzodiazepines rather than psychotropic medication generally; it also addresses difficulties in prescribing and managing use more directly than difficulty assessing appropriateness. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Addressing psychotropic use was considered difficult and time-consuming by doctors, with psychotropic discontinuation requiring more time than other medication.
“Addressing psychotropic use was considered difficult and time-consuming by doctors, with psychotropic discontinuation requiring more time than other medication [54, 56, 57, 59].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
In Results, physicians describe addressing benzodiazepine use in older adults as difficult and time-consuming, and say time constraints impede discontinuation. The paper does not establish that discontinuing psychotropics generally takes more time than discontinuing other medications; its comparison is with other medical problems competing for appointment time. Page numbers were not supplied in the passages. (LLM, conf=0.87)
Experimental — accuracy not yet measuredBarriers to non-pharmacological treatments included lack of time, training, funding, accessibility, volunteers or other resources, and older people not wishing to try psychological interventions.
“These included lack of time, training, funding, accessibility, volunteers or other resources [53, 54, 56, 59, 65, 81], and older people not wishing to try psychological interventions [54–56].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
The Results (Wider Organizational Factors and System Constraints; page not provided) identify limited physician time and poor reimbursement, and report physicians’ views that older patients might resist mental health referrals or face financial and transportation barriers. The Discussion describes physicians’ lack of preparation to address benzodiazepine use. The paper does not identify a lack of volunteers or establish every listed resource barrier to non-pharmacological treatment. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSome doctors criticized guidelines as being 'out of touch' with real-world problems and practice and discussed how over-regulation of psychotropic medication did not necessarily improve care.
“However, some doctors criticized guidelines as being ‘out of touch’ with real-world problems and practice and discussed how over-regulation of psychotropic medication did not necessarily improve care [53, 54, 81].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
The Results (page unavailable) explicitly say physicians criticized guidelines as out of touch with real-world problems. The Discussion (page unavailable) raises concerns that excluding benzodiazepines from Medicare coverage could disrupt appropriate care, but it does not report doctors discussing over-regulation of psychotropic medication generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredWhere older people rejected interventions such as bereavement counselling, doctors expressed a lack of alternatives.
“Where older people rejected interventions such as bereavement counselling, doctors expressed a lack of alternatives [54–56, 80].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
The Results section says physicians thought older patients would resist mental-health referrals, and that physicians lacked strategies for tapering benzodiazepines and providing alternative treatment. The Discussion likewise describes patient resistance alongside physicians’ lack of concrete strategies. The paper does not identify bereavement counselling as an intervention patients rejected, and reports physicians’ expectations rather than documented rejection by older patients. (LLM, conf=0.84)
Experimental — accuracy not yet measuredDoctors indicated that they did not necessarily agree with or promote long-term use; however, they discussed being more tolerant of long-term use in older people.
“Doctors indicated that they did not necessarily agree with or promote long-term use in; however, they discussed being more tolerant of long-term use in older people [54, 56, 59].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
Negative effects experienced by patients during prior attempts to discontinue were reported to discourage further attempts.
“Negative effects experienced by patients during prior attempts to discontinue were also reported to discourage further attempts [54–56, 74].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
Many doctors referred to the process of a risk-benefit analysis.
“Many doctors referred to the process of a risk–benefit analysis [53–56, 59, 65, 82].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
Some doctors were of the view that older people had a low potential for abuse and minimised or accepted the risks of addiction.
“Some doctors were also of the view that older people had a low potential for abuse and minimised or accepted the risks of addiction [54, 59, 74, 82].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [54]
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PSICOFÁRMACOS POTENCIALMENTE INAPROPRIADOS PARA IDOSOS
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- Authors
- Cook, J. M., Marshall, R., Masci, C., & Coyne, J. C.
- Affiliations
- Columbia University (US)
- New York State Psychiatric Institute (US)
- University of Pennsylvania (US)
- Corresponding author
- Cook, Joan M.
- ORCID
- Cook, Joan M.
- Venue
- Journal of General Internal Medicine
- Published
- 2007-01-25
- Volume
- 22
- Issue
- 3
- Pages
- 303-307
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC1824720
- OpenAlex
- W1972782221
- Cited by
- 178
- References
- 23
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 7 · 2023: 9 · 2022: 10 · 2021: 7 · 2020: 11 · 2019: 9 · 2018: 16 · 2017: 13 · 2016: 7 · 2015: 12 · 2014: 14 · 2013: 7 · 2012: 11
- FWCI
- 4.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R21MH068565, K01MH070859)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- benzodiazepines, older adults, chronic benzodiazepine use, benzodiazepine overuse, benzodiazepine tapering, benzodiazepine discontinuation, anxiety treatment, physician training, primary care
- MeSH terms
- Age Factors, Aged, Attitude of Health Personnel, Benzodiazepines, Family Practice, Female, Humans, Interviews as Topic, Male, Middle Aged, Patient Education as Topic, Physicians, Drug Prescriptions, Substance-Related Disorders
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